Evaluation of various electrocardiographic criteria for left ventricular hypertrophy in patients with stable angina pectoris: influence of using modified limb electrodes

Background: Left ventricular hypertrophy (LVH) in coronary heart disease is associated with poor prognosis. Electrocardiography (ECG) criteria for LVH , when using ECG with modified limb electrode positions, has not been valid ated in patients with angina pectoris. Methods Echocardiography and resting ECGs with modified limb electrode positions, i.e. with the limb leads plac ed on the abdomen instead of the extremities, were registered from 468 pati ents (295 men) with stable angina pectoris. To evaluate the influence of us ing modified limb electrode positions, ECGs with standard and modified limb electrode positions were compared in a control group consisting of 50 othe r patients. Results: The ECG criteria for LVH according to the Perugia scor e, the Minnesota code and Romhilt & Estes reached the highest sensitivity v alues, 27-31% in men and 24-38% in women. while the sensitivities of differ ent Cornell criteria were as low as 6-10% in men and 19-29% in women. In th e control group, the R- and S-wave amplitudes of the precordial leads were only slightly changed, as expected, whereas those of the limb leads changed considerably. Based on these results, we corrected aVL in the main study, which increased the sensitivity of the Cornell voltage criteria from 15 to 30%, while the specificity was maintained at 95%. Conclusions: ECGs registe red with modified limb electrode positions can be used to detect LVH with t raditional ECG criteria, but changes in the limb leads are considerable and influence the sensitivities.